Is the Uterus Removed in Fibroid Surgery? Myomectomy vs Hysterectomy

Two different operations under one name

In everyday language "fibroid surgery" is often thought of as a single procedure. Medically there are two. Myomectomy removes the fibroids from the uterine wall one by one and leaves the uterus in place; periods and the possibility of pregnancy are preserved. Hysterectomy removes the uterus entirely; periods stop and pregnancy is no longer possible. Fibroids cannot recur, because the organ they arise from is gone.

Myomectomy can be done by keyhole surgery (laparoscopic), through the uterine cavity (hysteroscopic) or as open surgery. The route depends on the location and size of the fibroids. We describe the approaches in detail on our myomectomy page.

When is removing the uterus discussed?

• In women with no pregnancy plans who have severe symptoms from many or very large fibroids, when a permanent solution is preferred.
• In women whose fibroids have regrown after a previous myomectomy and who do not want another uterus-sparing procedure.
• In women approaching menopause whose heavy bleeding cannot be controlled with medication and who do not prioritise keeping the uterus.
• When imaging shows findings that do not fit a fibroid and raise suspicion of a malignant tumour.

None of these means on its own that the uterus "must" be removed. The decision comes from weighing the woman’s own priorities together with the medical picture.

If the fibroid is large, is the uterus removed?

A large fibroid does not by itself require removing the uterus. In experienced hands, quite large fibroids can be removed by myomectomy; sometimes a short course of medication is given before surgery to shrink the fibroid and correct anaemia. Size is weighed not alone but together with the number and location of the fibroids, the overall state of the uterus and the wish for pregnancy.

Can the uterus be removed unexpectedly during surgery?

Converting a myomectomy planned to preserve the uterus into a hysterectomy is rare. It comes up only in an unexpected situation such as uncontrollable bleeding, to protect the patient’s life. This possibility is discussed before surgery and recorded on the consent form. If keeping your uterus matters to you, tell your surgeon clearly and settle the surgical plan together.

What happens to the ovaries if the uterus is removed?

Removing the uterus does not mean removing the ovaries. In premenopausal women the ovaries are usually left in place; because hormone production continues, the operation alone does not cause menopause. Removing the fallopian tubes to lower ovarian cancer risk is an option discussed before surgery.

Uterus-sparing options

• Myomectomy: the fibroids are removed surgically and the uterus is preserved; tissue can be examined.
• Fibroid embolisation: the vessels feeding the fibroid are blocked through a small entry at the groin or wrist; no incision is needed.
• HIFU (focused ultrasound): fibroid tissue is inactivated by heat from ultrasound energy focused from outside the body, with no incision in the abdominal skin; the uterus stays in place.
• Medication: can temporarily reduce bleeding and fibroid size; mostly used to prepare for surgery or as a bridge to menopause.

Questions you can ask your surgeon before the operation

• Is the planned operation a myomectomy or a hysterectomy, and why?
• In what situation would removing the uterus come up, and how likely is that for me?
• What is planned for my ovaries and tubes?
• Are the location and number of my fibroids suitable for uterus-sparing non-surgical methods?
• If I plan a pregnancy, which option is more suitable?